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Acute Lymphoblastic Leukemia (ALL)

What is acute lymphoblastic leukemia (ALL)?

Acute lymphoblastic leukemia (ALL) is a type of cancer that affects the blood and bone marrow. ALL can also be referred to as acute lymphocytic leukemia. In ALL, altered DNA in the bone marrow cells causes the production of immature white blood cells. These immature white blood cells turn into abnormal leukemia cells called lymphoblasts which then begin to outnumber the normal blood cells. The disease gets the word “acute” in its name because of the inability of the white blood cells to mature and from the disease’s capacity to progress quickly. This quick progression can then result in it spreading to other parts of the body (metastasize).

With ALL, prompt detection and treatment is important. ALL is the most common childhood cancer, but with proper treatment the prognosis is good. The disease is less common in adults and unfortunately has a poorer prognosis.

ALL is classified into subtypes based on the immunophenotype of the leukemia:

B-cell ALL

Early pre-B (also called pro-B)

Common

Pre-B

Mature B-cell (Burkitt leukemia)

T-cell ALL

Pre-T

Mature T-cell

*These classifications are named after the type of lymphocyte that the cancer cell originated from and its level of maturity*

Race/ethnicity (ALL occurs more often in whites than African Americans)

Diagnosis

A complete medical history and physical exam will be obtained and your physician will want to know any signs and symptoms you have had and for how long. Some tests that may be obtained to diagnose ALL include:

Complete blood count (CBC) and differential: The complete blood count looks at the number of red blood cells, white blood cells, and platelets. The differential count looks at the number of each type of white blood cell. People with ALL will typically have an elevated amount of immature white blood cells (lymphoblasts) and a decreased number red blood cells and platelets.

Peripheral blood smear: A drop of blood is looked at under a microscope to reveal any changes in the number/appearance of cells.

Bone marrow test: This test involves the aspiration of a sample of bone marrow that is then biopsied. The sample is taken from the hipbone using a needle but can sometimes be taken from the breast bone. The bone marrow cells will be looked at under a microscope to determine their types. If 20-30% of cells are immature this can be an indication of ALL.

Lumbar puncture: This test involves taking out a sample of cerebrospinal fluid (CSF) to detect the spread of cancerous cells.

X-rays, computerized tomography (CT) scan, or ultrasound: These imaging techniques can be used to detect the spread of the cancer to other body parts

Other tests:

Cytochemistry

Gallium and bone scan

Flow cytometry and immunohistochemistry

Fluorescent in situ hybridization (FISH)

Polymerase chain reaction (PCR)

Lymph node biopsy

Cytogenetics

Treatment

Different types of treatments are used based on the subtype of the ALL as well as other factors. Treatment length usually lasts about 2 years. Treatments may include:

Chemotherapy

Radiation therapy

Targeted drug therapy

Stem cell transplants

Clinical trials

# ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) BY THE NUMBERS #

The American Cancer Society found that there were approximately 5,970 new cases of ALL (3,350 in males and 2,620 in females) and approximately 1,440 deaths from ALL (800 in males and 640 in females) in 2017.

Finding the right doctor is a very important process. Treatment for blood disorders can be lengthy, which is why it is a good idea to make sure you have a strong relationship with your hematologist from the beginning. Here are three tips for choosing a hematologist:

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